Office

Office (Your Choice Care Ltd) is a domiciliary care agency providing personal care and support to people living in their own homes. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection there were two people who received personal care support.

People's experience of using this service and what we found

Since our last inspection, the provider had taken action and made improvements in how the service was managed. New and improved systems and processes had been introduced and whilst these were working well, further time was required for them to become fully embedded and sustained.

Systems and processes to keep people safe were effective. Risks associated with people’s healthcare and support needs had been reviewed. Staff had up to date and detailed guidance of how to manage and mitigate risks.

Medicines management followed best practice guidance and new and improved medicines audits and monitoring systems had been introduced. Whilst there had be no accidents or incidents since the last inspection, the provider had implemented a new system that would enable a review and learning from any events that occurred.

Recruitment processes had been reviewed and a robust recruitment procedure introduced. All staff had pre-employment checks completed, this included a criminal record check to ensure they were suitable to work with vulnerable people.

Staff training and support had been improved upon. Staff had received mandatory training the provider had identified as required. Action were ongoing to ensure staff became fully compliant with all training requirements. Staff received opportunities to discuss their work, training, and development needs.

The staff rota confirmed how staff were deployed to meet people’s individual needs. Staff recruitment was ongoing, and staff shortfalls were covered by the management team.

Infection prevention and control practice did not fully reflect best practice guidance. Where shortfalls were identified, these were raised with the provider and immediate action was taken. Staff had access to sufficient stock of personal protective equipment to reduce the risk of infection spread. Staff undertook weekly testing for COVID-19 and the provider had a system to monitor this.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The provider’s new and improved systems and processes enabled a person using the service, to have choice and control of their care and support.

At the time of the inspection, there was not a registered manager in place. The day to day management and responsibility for the service was with the nominated person and a director.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update.

The last rating for this service was Inadequate (published 30 June 2021) and there were multiple breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since the last inspection. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Office (Your Choice Care Ltd) on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Office (Your Choice Care Ltd) is a domiciliary care agency providing personal care and support to people living in their own homes. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection there were two people who received personal care support.

People’s experience of using this service and what we found

Systems and processes to keep people safe were ineffective. People did not have up to date risk assessments for known risks. Medicines administration and recording processes required strengthening. There were no effective systems to monitor accidents or incidents, which meant lessons could not be learned to reduce the risk of recurrence.

Recruitment processes were unsafe, assurances could not be provided staff were suitable to work with vulnerable people. Systems were not in place to ensure people were protected from abuse and the risk of abuse.

Staff had not received mandatory, refresher or specialist training for their roles. There was no system to monitor staff training, including from previous roles. There were no processes of formal staff support including supervisions, appraisals, team meetings or feedback surveys.

The provider did not have effective quality assurance systems to assess, monitor and improve the quality of all key areas of the service. There were no effective audits embedded into practice. The range of issues and concerns we found had not been identified prior to the inspection.

Mental capacity assessments were out of date and of poor quality. The staff team understood the principles of supporting people make choices.

Staff did not have access to up to date care plans. Care reviews were not recorded, and there was no evidence of people or their representatives being involved in care planning or reviews.

Although care plans were personalised, they were not up to date. A complaints process was in place, and in the process of being updated. Staff were confident any issues raised would be dealt with appropriately.

The provider and staff knew people well and wanted to ensure people received good quality care. Staff were caring in their approach, and supported people maintain their privacy, dignity and independence. The provider worked in partnership with health and social care professionals involved in people's care.

There was a small stable staff team who provided consistent care to people. Staff had access to sufficient stock of personal protective equipment (PPE) to reduce the risk of infection spread. Testing for COVID-19 took place and improvements were made to the frequency of testing during the course of the inspection.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Positive feedback was received from a professional working with the service about all aspects of a person’s progress and outcomes. However, as the service had ineffective systems and processes so they were unable to provide evidence of this.

The registered manager left the service prior to the inspection visit taking place. The provider was open and transparent throughout the inspection and provided assurances of urgent actions being taken to address the most serious concerns found. Since the inspection, the provider has continued to provide regular updates to CQC of priority actions being taken and is committed to making and embedding sustained improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

The service was registered with us on 27 June 2019 and this is the first inspection.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people receiving safe care and treatment, management oversight of the service, keeping people protected from abuse, staffing and the suitability of people working in the service.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.